Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 24 , ISSUE 2 ( February, 2020 ) > List of Articles

Original Article

Predictors of Acute Kidney Injury and Mortality in Intensive Care Unit at a Teaching Tertiary Hospital_ID

Justor Banda, Natasha Chenga, Suwilanji Nambaya, Tela Bulaya, Seter Siziya

Keywords : Acute kidney injury, Intensive care unit, Mortality, Predictors

Citation Information : Banda J, Chenga N, Nambaya S, Bulaya T, Siziya S. Predictors of Acute Kidney Injury and Mortality in Intensive Care Unit at a Teaching Tertiary Hospital_ID. Indian J Crit Care Med 2020; 24 (2):116-121.

DOI: 10.5005/jp-journals-10071-23352

License: CC BY-NC 4.0

Published Online: 20-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Background and aims: Despite the increased rates of acute kidney injury (AKI) in intensive care units (ICU) and associated mortality, information on the epidemiology of AKI is sparse in sub-Saharan Africa (SSA). We investigated the rates and predictors of AKI and associated mortality in a tertiary ICU. Materials and methods: This retrospective study analyzed 280 hospital records of patients admitted to the ICU at a tertiary teaching hospital who were aged ≥15 years from January 2017 to May 31, 2018. The outcome parameters of the study were rates of AKI in the ICU, associated risk factors, and mortalities. Acute kidney injury and ICU mortality were established by the multivariate logistic analysis. Results: The median age was 36 years (IQR 28, 52). The rate of AKI was 52.9%, and the presence of human immunodeficiency virus (HIV) and oliguria was 2.3-fold (0.004) and 4-fold (0.016) positive predictors of ICU-AKI, respectively. Male gender (0.003), diabetes mellitus (DM) (0.010), respiratory disease (0.001), inotropes (0.004), and ventilator support (0.017) were predictors for ICU mortality after controlling for confounders. Conclusion: The rate of AKI is significantly higher in a referral tertiary hospital in Zambia compared to developed countries and the presence of HIV and noncommunicable diseases such as DM impacts severely on outcomes.

  1. Abd ElHafeez S, Tripepi G, Quinn R, Naga Y, Abdelmonem S, AbdelHady M, et al. Risk, predictors, and outcomes of acute kidney injury in patients admitted to intensive care units in Egypt. Sci Rep 2017;7(1):1–8. DOI: 10.1038/s41598-017-17264-7.
  2. Santos PR, Monteiro DLS. Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study. BMC Nephrology 2015;16:1–6. DOI: 10.1186/s12882-015-0026-4.
  3. Halle MPE, Chipekam NM, Beyiha G, Fouda H, Coulibaly A, Hentchoya R, et al. Incidence, characteristics and prognosis of acute kidney injury in Cameroon: a prospective study at the Douala general hospital. Renal Failure 2018;40(1):30–37. DOI: 10.1080/0886022X.2017.1419970.
  4. Park WY, Hwang EA, Jang MH, Park SB, Kim HC. The risk factors and outcome of acute kidney injury in the intensive care units. Korean J Intern Med 2010;25(2):181–187. DOI: 10.3904/kjim.2010.25.2.181.
  5. Tejera D, Varela F, Acosta D, Figueroa S, Benencio S, Verdaguer C, et al. Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit. Rev Bras Ter Intensiva 2017;29(4):444–452. DOI: 10.5935/0103-507X.20170061.
  6. Makris K, Spanou L. Acute kidney injury: definition, pathophysiology and clinical phenotypes. Clin Biochem Rev 2016;37(2):85–98.
  7. Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob Health 2016;4(4):e242–e250. DOI: 10.1016/S2214-109X(15)00322-8.
  8. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  9. Gül F, Arslantaş MK, Cinel İ, Kumar A. Changing definitions of sepsis. Turkish J Anaesthesiol Reanim 2017;45(3):129–138. DOI: 10.5152/TJAR.2017.93753.
  10. Malhotra R, Kashani KB, Macedo E, Kim J, Bouchard J, Wynn S, et al. A risk prediction score for acute kidney injury in the intensive care unit. Nephrol Dial Transplant 2017;32(5):814–822. DOI: 10.1093/ndt/gfx026.
  11. Abd ElHafeez S, Bolignano D, D'Arrigo G, Dounousi E, Tripepi G, Zoccali C. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ Open 2018;8(1):1–32. DOI: 10.1136/bmjopen-2016- 015069.
  12. Peres LA, Wandeur V, Matsuo T. Predictors of acute kidney injury and mortality in an intensive care unit. J Bras Nefrol 2015;37:38–46. DOI: 10.5935/0101-2800.20150007.
  13. Vikrant S, Gupta D, Singh M. Epidemiology and outcome of acute kidney injury from a tertiary care hospital in India. Saudi J Kidney Dis Transpl 2018;29(4):956–966. DOI: 10.4103/1319-2442. 239633.
  14. Boswell MT, Rossouw TM. Approach to acute kidney injury in HIV-infected patients in south Africa. South Afr J HIV Med 2017;18(1):1–7. DOI: 10.4102/sajhivmed.v18i1.714.
  15. Vachiat AI, Musenge E, Wadee S, Naicker S. Renal failure in HIV-positive patients—a South African experience. Clin Kidney J 2013;6(6): 584–589. DOI: 10.1093/ckj/sft128.
  16. Wyatt CM. Kidney disease and HIV infection. Topics in antiviral medicine 2017;25(1):13–16.
  17. Fabian J, Naicker S. HIV and kidney disease in sub-Saharan Africa. Nat Rev Nephrol 2009;5(10):591–598. DOI: 10.1038/nrneph.2009.141.
  18. Kalim S, Szczech LA, Wyatt CM. Acute kidney injury in HIV-infected patients. Semin Nephrol 2008;28(6):556–562. DOI: 10.1016/j.semnephrol.2008.08.008.
  19. Li Y, Shlipak MG, Grunfeld C, Choi AI. Incidence and risk factors for acute kidney injury in HIV infection. Am J Nephrol 2012;35(4):327–334. DOI: 10.1159/000337151.
  20. Lopes JA, Melo MJ, Viegas A, Raimundo M, Camara I, Antunes F, et al. Acute kidney injury in hospitalised-HIV infected patients: a cohort analysis. Nephrol Dial Transplant 2011;26(12):3888–3894. DOI: 10.1093/ndt/gfr192.
  21. Li X, Zhuang S. Acute kidney injury in HIV infection. J Trop Dis 2013;1(1):1–11.
  22. Wyatt CM, Arons RR, Klotman PE, Klotman ME. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS 2006;20(4):561–565. DOI: 10.1097/01.aids.0000210610.52836.07.
  23. Seedat F, Martinson N, Motlhaoleng K, Abraham P, Mancama D, Naicker S, et al. Acute kidney injury, risk factors, and prognosis in hospitalized HIV-infected adults in south Africa, compared by Tenofovir exposure. AIDS Res Hum Retroviruses 2017;33(1):33–40. DOI: 10.1089/aid.2016.0098.
  24. Izzedine H, Baumelou A, Deray G. Acute renal failure in HIV patients. Nephrol Dial Transplant 2007;22(10):2757–2762. DOI: 10.1093/ndt/gfm404.
  25. Kalyesubula R, Perazella MA. Nephrotoxicity of HAART. AIDS Res Treat 2011; 1–11. DOI: 10.1155/2011/562790.
  26. Ponce D, Zorzenon Cde P, Santos NY, Teixeira UA, Balbi AL. Acute kidney injury in intensive care unit patients: a prospective study on incidence, risk factors and mortality. Rev BrasTer Intensiva 2011;23(3):321–326. DOI: 10.1590/S0103-507X2011000300010.
  27. Siddiqui S. Mortality profile across our intensive care units: a 5-year database report from a Singapore restructured hospital. Indian J Crit Care Med 2015;19(12):726–727. DOI: 10.4103/0972-5229. 171401.
  28. Sudarsanam TD, Jeyaseelan L, Thomas K, John G. Predictors of mortality in mechanically ventilated patients. Postgrad Med J 2005;81(962):780–783. DOI: 10.1136/pgmj.2005.033076.
  29. Smith ZA, Ayele Y, McDonald P. Outcomes in critical care delivery at Jimma University Specialised Hospital, Ethiopia. Anaesth Intensive Care, 2013;41(3):363–368. DOI: 10.1177/0310057X1304100314.
  30. Okafor UV. Challenges in critical care services in Sub-Saharan Africa: perspectives from Nigeria. Indian J Crit Care Med 2009;13(1):25–27. DOI: 10.4103/0972-5229.53112
  31. Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, et al. The influence of gender on the epidemiology of and outcome from severe sepsis. Critical Care 2013;17(2):R50. DOI: 10.1186/cc12570.
  32. Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans. Circulation 2002;106(16):2067–2072. DOI: 10.1161/
  33. Siegelaar SE, Hickmann M, Hoekstra JBL, Holleman F, DeVries JH. The effect of diabetes on mortality in critically ill patients: a systematic review and meta-analysis. Crit Care 2011;15(5):R205–R205. DOI: 10.1186/cc10440.
  34. Nasir N, Jamil B, Siddiqui S, Talat N, Khan FA, Hussain R. Mortality in sepsis and its relationship with Gender. Pak J Med Sci 2015;31(5): 1201–1206. DOI: 10.12669/pjms.315.6925.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.